Print Report | Back to Sample Detail

Sample Record for 2018-07-18-17

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 212995 DEA: 01262044 EFIS: 0112000203 QA Service Level: 1
DIST-CO-RTE-PM: 01-MEN-101-47.2/47.3
Work Description:
Location Description:
Contractor Address: 1324 S. State Street, Ukiah, CA 95482
Resident Engineer: Nash Munes Structure Rep.: Tatjana Halda

Sample Information

DIME Sample ID: 2018-07-18-17
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Acceptance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 07/18/2018
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 3 heats 1 powder
A brief description of the sample: A934 Purple Epoxy Coated Rebar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Eng

Material Information

Production or Authorization Testing: Retest
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size: 9
Nut Specification for Threaded Bar: ASTM A108
System Manufacturer: Williams Form Engineering
Epoxy Coating Color: Purple
Threaded Bar Application: Soil Nail
Coating Standards: ASTM A934 epoxy
Bar Heat Number(s): 100791753, 100891184, 100792512
Nut Heat Number(s): 8296508
Bar Lot Number: POG8744
Nut Lot Number: 9J1D
Coupler Heat Number(s): N/A
Coupler Grade: N/A

Test Results